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  1. Article: Uniportal video-assisted thoracic surgery Ivor-Lewis oesophagectomy with circular stapling anastomosis.

    Nachira, Dania / Biondi, Alberto / D'Ugo, Domenico / Margaritora, Stefano

    Journal of minimal access surgery

    2024  

    Abstract: Abstract: Amongst all minimally invasive oesophagectomies, uniportal video-assisted thoracic surgery (VATS) Ivor-Lewis remains the most challenging procedure due to the skills required for performing the intrathoracic anastomosis. We present an easy and ...

    Abstract Abstract: Amongst all minimally invasive oesophagectomies, uniportal video-assisted thoracic surgery (VATS) Ivor-Lewis remains the most challenging procedure due to the skills required for performing the intrathoracic anastomosis. We present an easy and safe circular stapling latero-terminal anastomosis for performing uniportal VATS Ivor-Lewis. The patient had an uneventful post-operative recovery and was disease-free 9 months after surgery.
    Language English
    Publishing date 2024-01-19
    Publishing country India
    Document type Journal Article
    ZDB-ID 2186884-0
    ISSN 1998-3921 ; 0972-9941
    ISSN (online) 1998-3921
    ISSN 0972-9941
    DOI 10.4103/jmas.jmas_184_23
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Case Report: The molecular fingerprint and the clinical implication of an exceptional response to neoadjuvant therapy in a metastatic cardia adenocarcinoma.

    Lorenzon, Laura / Campisi, Andrea / Di Paolo, Alessandra / Giuliante, Felice / Buttitta, Fiamma / D'Ugo, Domenico

    Frontiers in surgery

    2024  Volume 11, Page(s) 1297083

    Abstract: Background: Globally, gastric cancer holds the fifth position in terms of prevalence among malignant tumors and is the fourth leading cause of cancer-related mortality. Particular attention should be paid to cardia adenocarcinoma (CA) due to its ... ...

    Abstract Background: Globally, gastric cancer holds the fifth position in terms of prevalence among malignant tumors and is the fourth leading cause of cancer-related mortality. Particular attention should be paid to cardia adenocarcinoma (CA) due to its increasing incidence and poor prognosis. Diagnosis of CA frequently occurs in advanced stages because of its late symptoms. In such cases, neoadjuvant chemotherapy is the primary treatment option. The response to chemotherapy depends on multiple variables including the tumor's molecular profile, the patient's performance status, and the feasibility of using targeted therapy. Patients exhibiting an exceptional response, defined as a complete response to medical therapy lasting more than 1 year, or a partial response or stable disease lasting more than 2 years, are rarely described. This case report presents one of the longest-lasting exceptional responses to chemotherapy in metastatic cardia adenocarcinoma and discusses its clinical implications.
    Case presentation: A 49-year-old male patient presented with cardia adenocarcinoma (human epidermal growth factor receptor 2 negative, mismatch repair proficient) and liver metastases. Molecular profiling identified a pathogenic mutation in the TP53 gene (R123W; Arg123Trp) as the sole alteration found. Five months after initiating the neoadjuvant chemotherapy with fluorouracil-leucovorin-oxaliplatin-docetaxel, the patient achieved a complete clinical response. The molecular profile was compared with others previously documented in an international data portal, revealing a similar pattern. At 4 years and 3 months from diagnosis, the exceptional response was still confirmed. The patient underwent a cumulative number of 33 cycles of chemotherapy, leading to chemotherapy-induced liver damage.
    Conclusions: Exceptional responses to neoadjuvant chemotherapy in cardia adenocarcinomas are rarely reported. The documentation of exceptional responses to cancer therapies should be included in large data repositories to explore the molecular fingerprint of these tumors. In such cases, the clinical implications of long-term chemotherapy should always be taken into account.
    Language English
    Publishing date 2024-04-16
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2024.1297083
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Quality Over Volume: Modeling Centralization of Gastric Cancer Resections in Italy.

    Lorenzon, Laura / Biondi, Alberto / Agnes, Annamaria / Scrima, Ottavio / Persiani, Roberto / D'Ugo, Domenico

    Journal of gastric cancer

    2022  Volume 22, Issue 1, Page(s) 35–46

    Abstract: Background: The correlation between hospital volume and postoperative outcomes has led to the centralization of complex procedures in several countries. However, the results reported in relation to gastric cancer (GC) are contradictory. This study aimed ...

    Abstract Background: The correlation between hospital volume and postoperative outcomes has led to the centralization of complex procedures in several countries. However, the results reported in relation to gastric cancer (GC) are contradictory. This study aimed to analyze GC surgical volumes and 30-day postoperative mortality in Italy and to provide a simulation for modeling centralization of GC resections based on district case volumes.
    Methods: A national registry was used to identify all GC resections, record mortality rates, and track the national in-border GC resection health travel. Hospitals were grouped according to caseload. Centralization of all GC procedures performed within the same district was modeled. The outcome measures were a minimal volume of 25 GC resections/year and the 30-day postoperative mortality.
    Results: In 2018, 5,873 GC resections were performed in 498 Italian hospitals (mean resections per hospital per year: 11.8); the postoperative mortality rate (5.51%) was tracked from 2016-2018. GC resection health travel ranged from 2% to 50.5%, with a significant (P<0.001) difference between northern and central/southern Italy. The mean mortality rate was 7.7% in hospitals performing one to 3 GC resections per year, compared with 4.7% in those with >17 GC resections/year (P≤0.01). Most Italian districts achieved 25 procedures/year after centralization; however, 66.3% of GC cases in southern Italy vs. 42.2% in central and 52.7% in the northern regions (P<0.001) required reallocation.
    Conclusion: Postoperative mortality after GC resection correlated with hospital volume. Despite health travel, most Italian districts can reach a high-volume threshold, but discrepancies in mortality rates are alarming.Trial Registration
    Language English
    Publishing date 2022-02-24
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 2637180-7
    ISSN 2093-5641 ; 2093-582X
    ISSN (online) 2093-5641
    ISSN 2093-582X
    DOI 10.5230/jgc.2022.22.e4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Predictors of Clostridium difficile infection after stoma reversal following TaTME surgery.

    Tirelli, Flavio / Lorenzon, Laura / Biondi, Alberto / Langellotti, Lodovica / Santoro, Gloria / Agnes, Annamaria / Pezzuto, Roberto / Persiani, Roberto / D'Ugo, Domenico

    Updates in surgery

    2023  Volume 75, Issue 6, Page(s) 1589–1596

    Abstract: Background:  The aim of this study was to determine the incidence of Clostridium Difficile infection (CDI) after stoma reversal in patients who underwent transanal Total Mesorectal Excision (TaTME) and to evaluate variables correlated with this post- ... ...

    Abstract Background:  The aim of this study was to determine the incidence of Clostridium Difficile infection (CDI) after stoma reversal in patients who underwent transanal Total Mesorectal Excision (TaTME) and to evaluate variables correlated with this post-operative infection.
    Methods:  Patients who underwent stoma reversal surgery following TaTME for rectal cancer between 2015 and 2023 at a high-volume Institution, were retrospectively reviewed for the post-operative occurrence of diarrhea and in-hospital CDI (positive toxin in the stools). Patients were divided into the following subgroups according to the post-operative course: Group A-no clinical symptoms; Group B-mild diarrhea (< 10 evacuations/day); Group C-severe watery diarrhea (> 10 evacuations/day) with CDI negative; and Group D-severe watery diarrhea (> 10 evacuations/day) CDI positive. Clinical and laboratory data were analyzed for their correlation with CDI. A machine learning approach was used to determine predictors of diarrhea following stoma reversal.
    Results:  A total of 126 patients were selected, of whom 79 were assessed as Group A, 16 Group B, 25 Group C and 6 (4.8%) Group D. Univariable analysis documented that delayed stoma reversal correlated with CDI (Group A mean interval 44.6 weeks vs. Group D 68.4 weeks, p 0.01). The machine learning analysis confirmed the delay in stoma closure as a probability factor of presenting diarrhea; also, diarrhea probability was 80.5% in males, 77.8% in patients who underwent neoadjuvant therapy, and 63.9% in patients who underwent adjuvant therapy.
    Conclusions:  Stoma reversal surgery can result in moderate rate of in-hospital CDI. Time-to stoma reversal is a crucial variable significantly related with this adverse outcome.
    MeSH term(s) Male ; Humans ; Retrospective Studies ; Surgical Stomas/adverse effects ; Clostridium Infections/epidemiology ; Clostridium Infections/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Rectal Neoplasms/surgery ; Diarrhea/epidemiology ; Diarrhea/etiology
    Language English
    Publishing date 2023-08-04
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-023-01614-4
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  5. Article ; Online: Profiling complete regression after pre-operative therapy in gastric cancer patients using clinical and pathological data.

    Biondi, Alberto / Lorenzon, Laura / Santoro, Gloria / Agnes, Annamaria / Laurino, Antonio / Persiani, Roberto / D'Ugo, Domenico

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2023  Volume 49, Issue 11, Page(s) 106969

    Abstract: Introduction: The consistent use of pre-operative treatment before surgery for gastric cancer (GC) has resulted in increased rates of complete response. However, factors associated with response have been scantly investigated.: Methods: Patients with ...

    Abstract Introduction: The consistent use of pre-operative treatment before surgery for gastric cancer (GC) has resulted in increased rates of complete response. However, factors associated with response have been scantly investigated.
    Methods: Patients with GCs treated between 2017 and 2022 undergoing pre-operative treatment followed by resection were included. Clinicopathological data were analyzed for the association with tumor regression grades (TRG); secondary outcomes included the short-term overall (OS), disease-free (DFS) and disease specific survival (DSS).
    Results: Among 108 patients, 35.1% had an intestinal histotype GC, and 70.4% were treated with FLOT. Complete tumor regression (TRG1) was documented in 6.5% of patients. Univariable analyses documented that a higher pre-operative albumin (p = 0.04) and the expression of HER2 (p = 0.01) were associated to TRG1. In the multinominal regression model, the log-odds of being classified as TRG1 increased with the expression of HER2 by 170.247 times and with higher pre-operative albumin by 34.525 times, while with a higher Charlson Index and a diffuse hystotipe reduced it by 25.467 times and 3759.126 times, respectively. Among 49 patients (mean follow-up: 17.1 months), TRG1-2 was associated to better OS, DFS and DSS curves compared to TRG 3-5 (respectively p < 0.01, p 0.007 and p < 0.01), altogether with the reported negative impact of comorbidities in OS and DSS multivariable analyses (respectively p 0.04 and p 0.006). The random survival forest further confirmed the impact of HER2 and comorbidity on DSS.
    Conclusion: A better clinical profile, HER2 expression and intestinal histotype significantly correlated with GC regression. A complete-major response was an independent factor for survival.
    MeSH term(s) Humans ; Prognosis ; Stomach Neoplasms/surgery ; Stomach Neoplasms/drug therapy ; Treatment Outcome ; Disease-Free Survival ; Neoadjuvant Therapy ; Albumins
    Chemical Substances Albumins
    Language English
    Publishing date 2023-06-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2023.06.021
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  6. Article ; Online: The definition of "R1" lymph node dissection status in patients undergoing curative-aim gastrectomy for gastric carcinoma: A proof of concept study.

    Biondi, Alberto / Agnes, Annamaria / Laurino, Antonio / Moretta, Pasquale / Lorenzon, Laura / D'Ugo, Domenico / Persiani, Roberto

    Surgical oncology

    2023  Volume 48, Page(s) 101908

    Abstract: Introduction: The aim of this study was to define and investigate the prognostic impact of "R1-Lymph-node dissection" during gastrectomy.: Methods: This was a retrospective study conducted with 499 patients undergoing curative-aim gastrectomy. We ... ...

    Abstract Introduction: The aim of this study was to define and investigate the prognostic impact of "R1-Lymph-node dissection" during gastrectomy.
    Methods: This was a retrospective study conducted with 499 patients undergoing curative-aim gastrectomy. We defined R1-Lymph dissection as an involvement of lymph node stations anatomically connected with lymph node stations outside the declared level of dissection (D1 to D2+). The primary outcomes were disease-free and disease-specific survival (DFS and DSS).
    Results: At multivariable analysis, the type of gastrectomy, pT and pN were associated with DFS, and the type of gastrectomy, R1-Margin status, R1-Lymph status, pT, pN and adjuvant therapy were associated with DSS. Moreover, pT and R1-Lymph status were the only factors associated with overall loco-regional recurrence.
    Conclusions: In this study, we introduced the concept of R1-Lymph-node dissection, which was significantly associated with DSS and appeared to be a stronger prognostic factor for loco-regional recurrence than the R1 status on the resection margin.
    MeSH term(s) Humans ; Retrospective Studies ; Proof of Concept Study ; Lymph Node Excision ; Gastrectomy ; Stomach Neoplasms/pathology ; Carcinoma/surgery
    Language English
    Publishing date 2023-02-02
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1107810-8
    ISSN 1879-3320 ; 0960-7404
    ISSN (online) 1879-3320
    ISSN 0960-7404
    DOI 10.1016/j.suronc.2023.101908
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  7. Article ; Online: Predicting peritoneal recurrence after radical gastrectomy for gastric cancer: Validation of a prediction model (PERI-Gastric 1 and PERI-Gastric 2) on a Korean database.

    Belia, Francesco / Kim, Ki-Yoon / Agnes, Annamaria / Park, Sung Hyun / Cho, Minah / Kim, Yoo Min / Kim, Hyoung-Il / Persiani, Roberto / D'Ugo, Domenico / Biondi, Alberto / Hyung, Woo Jin

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2024  Volume 50, Issue 6, Page(s) 108359

    Abstract: Background: Peritoneal recurrence is a significant cause of treatment failure after radical gastrectomy for gastric cancer. The prediction of metachronous peritoneal recurrence would have a significantly impact risk stratification and tailored treatment ...

    Abstract Background: Peritoneal recurrence is a significant cause of treatment failure after radical gastrectomy for gastric cancer. The prediction of metachronous peritoneal recurrence would have a significantly impact risk stratification and tailored treatment planning. This study aimed to externally validate the previously established PERI-Gastric 1 and 2 models to assess their generalizability in an independent population.
    Methods: Retrospective external validation was conducted on a cohort of 8564 patients who underwent elective gastrectomy for stage Ib-IIIc gastric cancer between 1998 and 2018 at the Yonsei Cancer Center. Discrimination was tested using the area under the receiver operating characteristic curves (AUROC). Accuracy was tested by plotting observations against the predicted risk of peritoneal recurrence and analyzing the resulting calibration plots. Clinical usefulness was tested with a decision curve analysis.
    Results: In the validation cohort, PERI-Gastric 1 and PERI-Gastric 2 exhibited an AUROC of 0.766 (95 % C.I. 0.752-0.778) and 0.767 (95 % C.I. 0.755-0.780), a calibration-in-the-large of 0.935 and 0.700, a calibration belt with a 95 % C.I. over the bisector in the risk range of 24%-33 % and 35%-47 %. The decision curve analysis revealed a positive net benefit in the risk range of 10%-42 % and 15%-45 %, respectively.
    Conclusions: This study presents the external validation of the PERI-Gastric 1 and 2 scores in an Eastern population. The models demonstrated fair discrimination and satisfactory calibration for predicting the risk of peritoneal recurrence after radical gastrectomy, even in Eastern patients. PERI-Gastric 1 and 2 scores could also be applied to predict the risk of metachronous peritoneal recurrence in Eastern populations.
    Language English
    Publishing date 2024-04-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2024.108359
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  8. Article ; Online: The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review.

    Agnes, Annamaria / Puccioni, Caterina / D'Ugo, Domenico / Gasbarrini, Antonio / Biondi, Alberto / Persiani, Roberto

    BMC surgery

    2021  Volume 21, Issue 1, Page(s) 83

    Abstract: Background: The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the "missing factor" that could explain still poorly understood complications. Herein, we investigate this theory ... ...

    Abstract Background: The gut microbiota (GM) has been proposed as one of the main determinants of colorectal surgery complications and theorized as the "missing factor" that could explain still poorly understood complications. Herein, we investigate this theory and report the current evidence on the role of the GM in colorectal surgery.
    Methods: We first present the findings associating the role of the GM with the physiological response to surgery. Second, the change in GM composition during and after surgery and its association with colorectal surgery complications (ileus, adhesions, surgical-site infections, anastomotic leak, and diversion colitis) are reviewed. Finally, we present the findings linking GM science to the application of the enhanced recovery after surgery (ERAS) protocol, for the use of oral antibiotics with mechanical bowel preparation and for the administration of probiotics/synbiotics.
    Results: According to preclinical and translational evidence, the GM is capable of influencing colorectal surgery outcomes. Clinical evidence supports the application of an ERAS protocol and the preoperative administration of multistrain probiotics/synbiotics. GM manipulation with oral antibiotics with mechanical bowel preparation still has uncertain benefits in right-sided colic resection but is very promising for left-sided colic resection.
    Conclusions: The GM may be a determinant of colorectal surgery outcomes. There is an emerging need to implement translational research on the topic. Future clinical studies should clarify the composition of preoperative and postoperative GM and the impact of the GM on different colorectal surgery complications and should assess the validity of GM-targeted measures in effectively reducing complications for all colorectal surgery locations.
    MeSH term(s) Anastomotic Leak/prevention & control ; Anti-Bacterial Agents/administration & dosage ; Antibiotic Prophylaxis ; Colonic Diseases/complications ; Colonic Diseases/pathology ; Colonic Diseases/surgery ; Colorectal Surgery ; Digestive System Surgical Procedures/adverse effects ; Elective Surgical Procedures/adverse effects ; Enhanced Recovery After Surgery ; Gastrointestinal Microbiome ; Humans ; Postoperative Complications ; Preoperative Care/methods ; Probiotics ; Surgical Wound Infection/drug therapy ; Surgical Wound Infection/prevention & control
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2021-02-12
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2050442-1
    ISSN 1471-2482 ; 1471-2482
    ISSN (online) 1471-2482
    ISSN 1471-2482
    DOI 10.1186/s12893-021-01087-5
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  9. Article ; Online: A word for equity: the long road ahead.

    Lorenzon, Laura / Spolverato, Gaya / Frigerio, Isabella / D'Ugo, Domenico

    The American journal of emergency medicine

    2019  Volume 38, Issue 1, Page(s) 152–153

    MeSH term(s) Emergency Service, Hospital ; Intubation, Intratracheal
    Language English
    Publishing date 2019-11-08
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2019.158437
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  10. Article ; Online: The learning curve of TaTME for mid-low rectal cancer: a comprehensive analysis from a five-year institutional experience.

    Persiani, Roberto / Agnes, Annamaria / Belia, Francesco / D'Ugo, Domenico / Biondi, Alberto

    Surgical endoscopy

    2020  Volume 35, Issue 11, Page(s) 6190–6200

    Abstract: Background: Transanal total mesorectal excision (TaTME) was introduced in 2009 as a dedicated approach for the treatment of mid-low rectal cancer. We aimed to describe and discuss the learning curve for 121 consecutive TaTME procedures performed by the ... ...

    Abstract Background: Transanal total mesorectal excision (TaTME) was introduced in 2009 as a dedicated approach for the treatment of mid-low rectal cancer. We aimed to describe and discuss the learning curve for 121 consecutive TaTME procedures performed by the same team.
    Methods: The primary outcome was the number of operations required to decrease the mean operative time (mOT). The secondary outcomes were the number of operations required to decrease the major complication (MC) rate, the anastomotic leakage (AL) rate, the clinical anastomotic failure rate, and the reoperation rate. A cumulative sum (CUSUM) curve analysis was used to identify the inflection points. As an integrative analysis, Bernoulli CUSUM curves, risk-adjusted CUSUM curves based on the observed-expected outcomes, and CUSUM curves targeting results reported in the literature were created.
    Results: Seventy-one cases were needed to overcome the OT learning curve sufficiently to reach mastery. The MC and reoperation rates started to decrease after the 54th case and further decreased after the 69th case. The AL rate started to decrease after the 27th case and remained stable at 5-5.1%. The comparison between the different phases of the learning curves confirmed these turning points.
    Conclusions: TaTME had a learning curve of 71 cases for the mOT, 55-69 cases for MCs and reoperation, and 27 cases for AL. According to our results, attention should be paid during the first part of the learning curve to avoid an increased rate of MCs and AL.
    MeSH term(s) Humans ; Laparoscopy ; Learning Curve ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Rectal Neoplasms/surgery ; Rectum ; Transanal Endoscopic Surgery ; Treatment Outcome
    Language English
    Publishing date 2020-10-26
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-020-08115-0
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